Good Faith Estimate Information

You have the right to receive a good faith estimate of what your services may cost. This good faith estimate is required by the federal No Surprises Act and will be based on information that I know at the time the estimate is created.

The good faith estimate for your therapy service will be based on the payment rate, number of sessions, and type and length of sessions anticipated. This is not a contract and it does not obligate you to accept services.

It is not possible for me to know in advance the exact cost of your therapy service as this varies by what is needed and appropriate for each individual. The good faith estimate is an estimate of what is reasonably expected; your final cost will be determined by what is appropriate for your individual needs.

More detailed information about what is involved in a good faith estimate will be provided in the Good Faith Estimate given to you.

It is important to me that I provide the information to you in a way that is accessible for you so please let me know if you need any accommodations or have a particular format in which you would like to receive it. I’ll also be glad to answer any questions you may have.

If you have insurance coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE, those programs already have protections against surprise medical billing and the No Surprises Act does not apply to you.

You can find more information regarding good faith estimates and the No Surprises Act at www.CMS.gov/nosurprises